CURRENT POLITICS

Healthcare is not a commodity
: no matter what neo-liberalism has taught us

Humphrey McQueen article in The Guardian, 22 May 2014

Even the staunchest opponents of neoliberalism have been infected by its presumptions. The current Australian healthcare debate is our moment to re-learn what universal provision actually is

"We are all socialists now", said Britain’s chancellor of the exchequer, William Harcourt, in 1894. He was remarking that his liberal opponents were united in favour of municipal reservoirs. Should socialists today intone, "We are all neo-liberals now"? Not that we support selling off the waterworks; rather, 120 years after Harcourt, we have been forced to defend the (figurative) water supply against those who would.

Opponents of neoliberalism have absorbed several of its presumptions. The most pervasive is to repeat the lie that sell-offs are privatisations. To say private and not corporate is to do the work of our enemy’s spin doctors. The word private makes the counting-house sound neighbourly. Similar mischiefs flow from parroting reform instead of denouncing de-forms.

Health is the latest and most prominent de-form, even though education, employment, housing and transport are also subject to similar inequities. Unequal outcomes from those five pillars of everyday life compound each other, perhaps nowhere more so than for mental illness.

Our well-being is the outcome of their interaction, not just a physical condition of an individual. As the socialist epidemiologist Fiona Stanley puts it, the real brain drain begins before birth. Hence, provisions for equitable care have to be built on "social" equality. Every policy should face this test: is it likely to increase social equality across the generations?

From that starting point, I have always been critical of Medicare (and its ancestor, Medibank) as a curative model funded in part by a flat-rate tax. My objection has never been to a universal system but to the fact that Medicare has never been one. Nothing here has come within coo-ee of Britain’s national health service.

I appreciate the benefits of Medicare. Without it, in the United Mistakes for example, I would be either dead or homeless. As it was, from 2001 I was at least $5,000 out of pocket for treatment-related costs over five years of diagnosis and follow-up, not including loss of earnings.

The surgeon warned that I would never again be able to bend it like Beckham but that the loss of a thigh muscle was a small price to pay for being alive. So was the $5,000. Nonetheless, its outlay was a reminder of how far Medicare has always been from universal coverage. Not everyone has the funds or friendships to meet essential extras.

Despite these long-standing complaints about Medicare, I caught myself frothing against a co-payment for GP visits. That surprise sent me back to the source of my objections, Richard Titmuss’ 1962 tome, Income Distribution and Social Change. He showed why universal service delivery is the only route towards greater social equality, because in a single system of healthcare the rich and powerful have a life-and-death interest in making it work.

So what's our task? We need to fight our way out of the corner into which neoliberalism has backed us, and insist on universal systems funded by steeply progressive tax-rates on capital more than on profits, on property as well as on income.

The Coalition's proposed $7 co-payment is regressive. But the flat-rate Medicare tax, even though it requires those on average weekly earnings to pay a larger lump sum than someone on the minimum wage, isn't much better. 1% on $35,000 of taxable income collects $350; on $70,000, it is twice as much at $700. That doubling is not progressive.

A progressive rate would run like this: 1% stays at $350 out of $35,000; but 2% on $70,000 would be $1,400. Instead of the higher income earner paying only twice as much in total, she would contribute four times as much. However, higher earners are more likely to reduce the taxable component of their income by deductions and dodges – they must be abolished.

Medibank and Medicare taught us to wear this kind of flat-rate impost – the GST, the flood levy, and the national disability insurance scheme. Now we have the deficit tax. My only objection to the last is that it is not permanent and not steep enough. In an ideal world, Westpac’s Gail Kelly and her mates would be on a marginal rate of 90%.

In a further concession to neoliberalism, we're all encouraged to advocate equality of opportunity when the call should be for equality of outcomes. It is one thing for every Australian to have the same rate of access to heart surgery. It is another to get the same quality of care at Bourke as in the Jesus Hilton (aka St Vincent’s Private).

Too few defenders of Medicare recall the community health program (CHP) from the 1970s. The first CHP was set up in 1964, in Footscray, Melbourne, by the Australian meat industry employees union. Its purpose was to offer treatment to injured meat workers and research the causes of industrial accidents.

The trade union clinic and research centre, as it was called, became the model for similar services for women and Indigenous Australians which still exist today. Campaigners for the extension of Medicare need to put an even greater effort into rejuvenating CHP centres, to make them our universal provider. They should be the heart, brain and lungs of wellness in every community and at every workplace.

But such a thing seems difficult today, if not impossible. It's not that neoliberalism is a vicious idea in the twisted minds of evil people, whether John Howard and Tony Abbott, or Julia Gillard and Bill Shorten. Neoliberalism expresses the necessity that capital has to expand by commodifying every aspect of our lives.

To prevent the spread of that disease it is essential to reassert the vision that Titmuss celebrated in his 1970 masterpiece, The Gift Relationship. He contrasted volunteer UK blood donors with the US victims of a free market in plasma and saw that health care has almost none of the characteristics of a consumer good.

Nevertheless, Australia's commonwealth serum laboratories were privatised in 1994, under Paul Keating, who made Medicare a key plank of his "social wage". How long will it be before the efficiency of supplying blood is totally de-formed by market signals? If we go on settling for Medicare, for the third best, we shall end up with a futures market in blood.

Titmuss was right: healthcare is not a product. Unlike when we buy shoes, as patients we have little idea of what treatments we will need. Finally, we are not in a position to return them, least of all from the grave.